Mortality after surgery in Europe: a 7 day cohort study

Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
The Lancet (Impact Factor: 39.21). 09/2012; 380(9847):1059-1065. DOI: 10.1016/S0140-6736(12)61148-9

ABSTRACT The Lancet, 380 (2012) 1059-1065. doi:10.1016/S0140-6736(12)61148-9

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    ABSTRACT: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery. This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation (APACHE) II score of at least 10 who were ready to be transferred to the surgical ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. In total, 286 patients were included in the modified intention-to-treat analysis. The trial was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310). Postoperative intermediate care had no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. Registration number: NCT01209663 ( © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.
    British Journal of Surgery 03/2015; DOI:10.1002/bjs.9749 · 5.21 Impact Factor
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    ABSTRACT: Background Changes in health-related quality of life (HRQoL) several days after surgery have rarely been investigated. We aimed to estimate the perioperative change of HRQoL, to identify patients with clinically relevant decrease in postoperative HRQoL and to establish factors associated with this decrease in HRQoL at day 30 after major surgery.Methods Patients scheduled for major surgery at a university hospital were enrolled. Based on the HRQoL SF-12 questionnaire, the preoperative physical component summary (PCS) score, preoperative mental component summary (MCS) score, and postoperative PCS and MCS scores at day 30 were recorded. Minimal clinically important difference (MCID) was defined as those with a decrease of at least one half of the standard deviation (SD) of preoperative PCS or MCS scores. Differences between the groups with or without decreased HRQoL were investigated using univariate comparisons. A multiple logistic regression model was performed to evaluate the predictive value of potential perioperative variables.ResultsThe mean¿±¿SD preoperative PCS score was 38.5¿±¿10.6, postoperative score was 35.1¿±¿7.8 (p¿=¿.004) in 85 patients. Thirty-five patients (41.2%) had a clinically relevant decrease of the postoperative PCS score. A normal to high preoperative exercise metabolic capacity measured with metabolic equivalent of task (MET) (p¿=¿.01) was a predictor of the decrease in postoperative PCS. The mean preoperative MCS scores (p¿=¿.395) were 42.2 (SD 12.8) preoperative, and 43.45 (SD 12.4) postoperative, respectively.Conclusions Major surgery decreases postoperative PCS scores of HRQoL at 30 days. A normal to high exercise capacity was a predictor of a clinically relevant decrease of postoperative PCS scores.Trial registration07¿107 (Ethical Committee NAC of Geneva University Hospitals).
    Health and Quality of Life Outcomes 02/2015; 13(1):12. DOI:10.1186/s12955-014-0194-0 · 2.10 Impact Factor
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    ABSTRACT: Introduction: The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU.
    Critical Care 01/2015; 18(6):551. DOI:10.1186/s13054-014-0551-8 · 5.04 Impact Factor